Basic Information
| Provider Information | |||||||||
| NPI: | 1619399888 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UMPQUA COMMUNITY HEALTH CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 NE KENNETH FORD DR | ||||||||
| Address2: | |||||||||
| City: | ROSEBURG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974701042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416729596 | ||||||||
| FaxNumber: | 5414643519 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 PONDEROSA DR | ||||||||
| Address2: | |||||||||
| City: | SUTHERLIN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974799812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416729596 | ||||||||
| FaxNumber: | 5414643519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2014 | ||||||||
| LastUpdateDate: | 06/28/2022 | ||||||||
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| AuthorizedOfficialLastName: | BOLTON | ||||||||
| AuthorizedOfficialFirstName: | KC | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5416729596 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
No ID Information.